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Why This Quiet Grant-Making Agency Is Key to Health Care’s Future

This year’s congressional debate on health care has shined a light on several vulnerable populations, including Americans living with pre-existing conditions, suffering from opioid use disorder, residing in rural America, and being underinsured or uninsured.  Imagine if there was a federal agency that focused on these very populations to ensure that in case they fell through the cracks of our health care system there would be a safety net to catch them.  In fact, there is.

Nestled in the suburbia of Rockville, MD lies the Health Resources Services Administration (HRSA), an agency of the U.S. Department of Health & Human Services (HHS).  Though not as well-known as its sister agencies such as the Centers for Disease Control & Prevention (CDC) or the Food & Drug Administration, HRSA’s total budget is larger than both of those entities. Each year, HRSA impacts thousands of health care and public health organizations, tens of thousands of healthcare practitioners, and tens of millions of Americans.

For example, in 2017, HRSA will support over 10,000 community health center sites in serving 24 million people, its maternal and child health program will serve more than 50 million women, infants and children, and its National Health Service Corps (NHSC) will place over 10,000 healthcare professionals in areas with limited access to care. Beyond this, HRSA programs provide medical care, treatment and support services for more than 500,000 people impacted by HIV/AIDS and oversee the country’s organ transplantation system.

The opportunity for HRSA to play a substantially larger role in health care transformation and public health revitalization cannot be understated

President Trump’s FY 2018 budget proposes a 10 percent reduction to the agency’s discretionary budget.  Several proposals are perplexing, including a 50 percent reduction to the Federal Office of Rural Health Policy although rural health is in crisis with many hospitals on the brink of closures (the recently passed Labor-HHS Appropriations bill by the House Appropriations Committee maintained funds for this office at its 2017 level). 

While it is unclear whether Congress will be able to pass an appropriations bill before the end of the fiscal year, a more immediate concern is the “funding cliff” for community health centers and for the NHSC which would occur if there is no legislative action by September 30. The Bipartisan Policy Center has recommended extending funding of community health centers at current total levels of $5.1 billion annually (including both mandatory and appropriated funding), through FY2021 and extending funding of the NHSC at current levels of $310 million per year through FY2021. Other substantial cuts, for example, to health workforce programs focused on geriatrics, primary care, oral health, and nursing also appear to have been rejected by the House bill though they still reflect the President’s vision by reducing funding for some programs and eliminating others.  This is concerning given the need for health professionals to care for an increasingly insured and aging American population seeking care. 

As Congress continues to consider HRSA’s appropriations, it’s imperative that it reassess these specific areas, most of which have consistently received bipartisan support over the years.  As a measure of good governance, Congress should also ideally reauthorize HRSA programs that have expired but continue to receive appropriations.

Beyond the legislative realm, an equally significant opportunity exists to support HRSA at the executive branch level. HHS Secretary Dr. Tom Price should “elevate” the agency by transitioning it from a solely grant-making agency to one which fully unleashes its unique reach and assets to help transform the US health care and public health systems.

Congress should also ideally reauthorize HRSA programs that have expired but continue to receive appropriations. 

Specifically, HRSA can demonstrate that comprehensive primary care, which integrates behavioral health, dentistry, pharmacy, and referrals to community health services, leads to superior health outcomes, reduced preventable healthcare costs, and reduced health disparities.  As an example, in 2015, 70 percent of adult community health center patients with type 1 or 2 diabetes had their most recent hemoglobin A1c under control compared to 54 percent nationally and 64 percent of patients with diagnosed hypertension had their blood pressure under adequate control compared to 52 percent nationally. In terms of costs, community health center Medicaid patients had lower use and spending than did non-health center patients across all services with total spending 24 percent lower for health center patients.

HRSA can also demonstrate that its support for public health programs substantially impacts leading national health indicators.  As an example, HRSA’s maternal child and health program has played a lead role in the 18 percent reduction in infant mortality in the U.S. between 1997 and 2015 and the 8 percent increase in early prenatal care in the U.S. between 2007 and 2015.

In addition, HRSA must be the federal government’s leader in developing a national healthcare workforce strategy, leading the charge towards an AIDS-free generation, championing a national grand challenge to increase organ donation, reimagining the delivery of healthcare in rural America, and identifying how underserved populations can more fairly access affordable medicines.

For all these aspirations to be met, HRSA will need to continue having a thorough understanding of the needs of its grantees and of the health care and public health environment in general.  It will also need to continue to leverage relationships with sister HHS agencies such as the Centers for Medicare and Medicaid Services, the Substance Abuse and Mental Health Services Administration, and CDC, to promote alignment and synergy.  Finally, a continued rigorous focus on tracking metrics that demonstrate improved health outcomes and outputs will be critical.

The opportunity for HRSA to play a substantially larger role in health care transformation and public health revitalization cannot be understated.  It is time to bring HRSA out from the shadows so that the nation recognizes the agency’s important role and its citizens, particularly those who are vulnerable, benefit even more from its myriad programs and initiatives.  This should be a bipartisan priority we can all agree on.   

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